|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$141.55
|
|
|
Service Code
|
NDC 00143992950
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$127.39 |
| Rate for Payer: Aetna American Axle |
$92.01
|
| Rate for Payer: Aetna Commercial |
$120.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.01
|
| Rate for Payer: Cash Price |
$113.24
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.24
|
| Rate for Payer: Healthscope Commercial |
$127.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.32
|
| Rate for Payer: PHP Commercial |
$120.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.01
|
| Rate for Payer: Priority Health SBD |
$89.18
|
| Rate for Payer: UMR Bronson Commercial |
$62.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.16
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$887.82
|
|
|
Service Code
|
NDC 62135031050
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$390.64 |
| Max. Negotiated Rate |
$799.04 |
| Rate for Payer: Aetna American Axle |
$577.08
|
| Rate for Payer: Aetna Commercial |
$754.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$577.08
|
| Rate for Payer: Cash Price |
$710.26
|
| Rate for Payer: Cofinity Commercial |
$621.47
|
| Rate for Payer: Cofinity Commercial |
$763.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$621.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$710.26
|
| Rate for Payer: Healthscope Commercial |
$799.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$621.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.65
|
| Rate for Payer: PHP Commercial |
$754.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.08
|
| Rate for Payer: Priority Health SBD |
$559.33
|
| Rate for Payer: UMR Bronson Commercial |
$390.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.87
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
OP
|
$184.78
|
|
|
Service Code
|
NDC 65862007850
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$166.30 |
| Rate for Payer: Aetna American Axle |
$120.11
|
| Rate for Payer: Aetna Commercial |
$157.06
|
| Rate for Payer: Aetna Medicare |
$92.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.11
|
| Rate for Payer: BCBS Complete |
$73.91
|
| Rate for Payer: Cash Price |
$147.82
|
| Rate for Payer: Cofinity Commercial |
$129.35
|
| Rate for Payer: Cofinity Commercial |
$158.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.82
|
| Rate for Payer: Healthscope Commercial |
$166.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.06
|
| Rate for Payer: PHP Commercial |
$157.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.11
|
| Rate for Payer: Priority Health SBD |
$116.41
|
| Rate for Payer: UMR Bronson Commercial |
$68.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.59
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$141.55
|
|
|
Service Code
|
NDC 55111012850
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$127.39 |
| Rate for Payer: Aetna American Axle |
$92.01
|
| Rate for Payer: Aetna Commercial |
$120.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.01
|
| Rate for Payer: Cash Price |
$113.24
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.24
|
| Rate for Payer: Healthscope Commercial |
$127.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.32
|
| Rate for Payer: PHP Commercial |
$120.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.01
|
| Rate for Payer: Priority Health SBD |
$89.18
|
| Rate for Payer: UMR Bronson Commercial |
$62.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.16
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$189.53
|
|
|
Service Code
|
NDC 59651087350
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.39 |
| Max. Negotiated Rate |
$170.58 |
| Rate for Payer: Aetna American Axle |
$123.19
|
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.19
|
| Rate for Payer: Cash Price |
$151.62
|
| Rate for Payer: Cofinity Commercial |
$132.67
|
| Rate for Payer: Cofinity Commercial |
$163.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.62
|
| Rate for Payer: Healthscope Commercial |
$170.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.10
|
| Rate for Payer: PHP Commercial |
$161.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.19
|
| Rate for Payer: Priority Health SBD |
$119.40
|
| Rate for Payer: UMR Bronson Commercial |
$83.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.15
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
OP
|
$887.82
|
|
|
Service Code
|
NDC 62135031050
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$328.49 |
| Max. Negotiated Rate |
$799.04 |
| Rate for Payer: Aetna American Axle |
$577.08
|
| Rate for Payer: Aetna Commercial |
$754.65
|
| Rate for Payer: Aetna Medicare |
$443.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$577.08
|
| Rate for Payer: BCBS Complete |
$355.13
|
| Rate for Payer: Cash Price |
$710.26
|
| Rate for Payer: Cofinity Commercial |
$621.47
|
| Rate for Payer: Cofinity Commercial |
$763.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$621.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$710.26
|
| Rate for Payer: Healthscope Commercial |
$799.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$621.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.65
|
| Rate for Payer: PHP Commercial |
$754.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.08
|
| Rate for Payer: Priority Health SBD |
$559.33
|
| Rate for Payer: UMR Bronson Commercial |
$328.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.87
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$184.78
|
|
|
Service Code
|
NDC 65862007850
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.30 |
| Max. Negotiated Rate |
$166.30 |
| Rate for Payer: Aetna American Axle |
$120.11
|
| Rate for Payer: Aetna Commercial |
$157.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.11
|
| Rate for Payer: Cash Price |
$147.82
|
| Rate for Payer: Cofinity Commercial |
$129.35
|
| Rate for Payer: Cofinity Commercial |
$158.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.82
|
| Rate for Payer: Healthscope Commercial |
$166.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.06
|
| Rate for Payer: PHP Commercial |
$157.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.11
|
| Rate for Payer: Priority Health SBD |
$116.41
|
| Rate for Payer: UMR Bronson Commercial |
$81.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.59
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
OP
|
$189.53
|
|
|
Service Code
|
NDC 59651087350
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.13 |
| Max. Negotiated Rate |
$170.58 |
| Rate for Payer: Aetna American Axle |
$123.19
|
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Medicare |
$94.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.19
|
| Rate for Payer: BCBS Complete |
$75.81
|
| Rate for Payer: Cash Price |
$151.62
|
| Rate for Payer: Cofinity Commercial |
$132.67
|
| Rate for Payer: Cofinity Commercial |
$163.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.62
|
| Rate for Payer: Healthscope Commercial |
$170.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.10
|
| Rate for Payer: PHP Commercial |
$161.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.19
|
| Rate for Payer: Priority Health SBD |
$119.40
|
| Rate for Payer: UMR Bronson Commercial |
$70.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.15
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
OP
|
$141.55
|
|
|
Service Code
|
NDC 55111012850
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.37 |
| Max. Negotiated Rate |
$127.39 |
| Rate for Payer: Aetna American Axle |
$92.01
|
| Rate for Payer: Aetna Commercial |
$120.32
|
| Rate for Payer: Aetna Medicare |
$70.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.01
|
| Rate for Payer: BCBS Complete |
$56.62
|
| Rate for Payer: Cash Price |
$113.24
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.24
|
| Rate for Payer: Healthscope Commercial |
$127.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.32
|
| Rate for Payer: PHP Commercial |
$120.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.01
|
| Rate for Payer: Priority Health SBD |
$89.18
|
| Rate for Payer: UMR Bronson Commercial |
$52.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.16
|
|
|
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE
|
Facility
|
OP
|
$5,623.80
|
|
|
Service Code
|
CPT 54161
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,818.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
CIRCUMCISION, USING CLAMP OR OTHER DEVICE WITH REGIONAL DORSAL PENILE OR RING BLOCK
|
Facility
|
OP
|
$5,623.80
|
|
|
Service Code
|
CPT 54150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,818.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.90
|
|
|
Service Code
|
NDC 63323041605
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$35.01 |
| Rate for Payer: Aetna American Axle |
$25.29
|
| Rate for Payer: Aetna Commercial |
$33.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.29
|
| Rate for Payer: Cash Price |
$31.12
|
| Rate for Payer: Cofinity Commercial |
$27.23
|
| Rate for Payer: Cofinity Commercial |
$33.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.12
|
| Rate for Payer: Healthscope Commercial |
$35.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.06
|
| Rate for Payer: PHP Commercial |
$33.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.29
|
| Rate for Payer: Priority Health SBD |
$24.51
|
| Rate for Payer: UMR Bronson Commercial |
$17.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.18
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$95.19
|
|
|
Service Code
|
NDC 00703205601
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$38.90
|
|
|
Service Code
|
NDC 63323041605
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$35.01 |
| Rate for Payer: Aetna American Axle |
$25.29
|
| Rate for Payer: Aetna Commercial |
$33.06
|
| Rate for Payer: Aetna Medicare |
$19.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.29
|
| Rate for Payer: BCBS Complete |
$15.56
|
| Rate for Payer: Cash Price |
$31.12
|
| Rate for Payer: Cofinity Commercial |
$27.23
|
| Rate for Payer: Cofinity Commercial |
$33.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.12
|
| Rate for Payer: Healthscope Commercial |
$35.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.06
|
| Rate for Payer: PHP Commercial |
$33.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.29
|
| Rate for Payer: Priority Health SBD |
$24.51
|
| Rate for Payer: UMR Bronson Commercial |
$14.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.18
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.73
|
|
|
Service Code
|
NDC 00781315095
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.73
|
|
|
Service Code
|
NDC 00781315095
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna Medicare |
$9.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$65.26
|
|
|
Service Code
|
NDC 00074437805
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.71 |
| Max. Negotiated Rate |
$58.73 |
| Rate for Payer: Aetna American Axle |
$42.42
|
| Rate for Payer: Aetna Commercial |
$55.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.42
|
| Rate for Payer: Cash Price |
$52.21
|
| Rate for Payer: Cofinity Commercial |
$45.68
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.21
|
| Rate for Payer: Healthscope Commercial |
$58.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.47
|
| Rate for Payer: PHP Commercial |
$55.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.42
|
| Rate for Payer: Priority Health SBD |
$41.11
|
| Rate for Payer: UMR Bronson Commercial |
$28.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.95
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.73
|
|
|
Service Code
|
NDC 00781315075
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65.26
|
|
|
Service Code
|
NDC 00074437805
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$58.73 |
| Rate for Payer: Aetna American Axle |
$42.42
|
| Rate for Payer: Aetna Commercial |
$55.47
|
| Rate for Payer: Aetna Medicare |
$32.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.42
|
| Rate for Payer: BCBS Complete |
$26.10
|
| Rate for Payer: Cash Price |
$52.21
|
| Rate for Payer: Cofinity Commercial |
$45.68
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.21
|
| Rate for Payer: Healthscope Commercial |
$58.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.47
|
| Rate for Payer: PHP Commercial |
$55.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.42
|
| Rate for Payer: Priority Health SBD |
$41.11
|
| Rate for Payer: UMR Bronson Commercial |
$24.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.95
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$95.19
|
|
|
Service Code
|
NDC 00703205603
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$95.19
|
|
|
Service Code
|
NDC 00703205603
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$95.19
|
|
|
Service Code
|
NDC 00703205601
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.73
|
|
|
Service Code
|
NDC 00781315075
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna Medicare |
$9.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$233.88
|
|
|
Service Code
|
NDC 00409110301
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.54 |
| Max. Negotiated Rate |
$210.49 |
| Rate for Payer: Aetna American Axle |
$152.02
|
| Rate for Payer: Aetna Commercial |
$198.80
|
| Rate for Payer: Aetna Medicare |
$116.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.02
|
| Rate for Payer: BCBS Complete |
$93.55
|
| Rate for Payer: Cash Price |
$187.10
|
| Rate for Payer: Cofinity Commercial |
$163.72
|
| Rate for Payer: Cofinity Commercial |
$201.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.10
|
| Rate for Payer: Healthscope Commercial |
$210.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.80
|
| Rate for Payer: PHP Commercial |
$198.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.02
|
| Rate for Payer: Priority Health SBD |
$147.34
|
| Rate for Payer: UMR Bronson Commercial |
$86.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.41
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$213.78
|
|
|
Service Code
|
NDC 63323041820
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.06 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna American Axle |
$138.96
|
| Rate for Payer: Aetna Commercial |
$181.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.96
|
| Rate for Payer: Cash Price |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$149.65
|
| Rate for Payer: Cofinity Commercial |
$183.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.02
|
| Rate for Payer: Healthscope Commercial |
$192.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.71
|
| Rate for Payer: PHP Commercial |
$181.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.96
|
| Rate for Payer: Priority Health SBD |
$134.68
|
| Rate for Payer: UMR Bronson Commercial |
$94.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.34
|
|
